Single-Use Reamer Shafts for Intramedullary Nail Fixation: An Addressable Source of Extraneous Cost and Medical Waste in Orthopaedic Surgery.

OBJECTIVES

To analyze the impact of switching from single-use reamer shafts to reusable reamer shafts for intramedullary nail fixation (IMN) of femur and tibia fractures at a single Level 1 trauma center, regarding cost, metal waste, and infection rates.

DESIGN

Retrospective comparison study.

SETTING

Level 1 trauma center.

PATIENTS/

PARTICIPANTS

Patients with operative femur and tibia fractures treated before and after adoption of a reusable reamer shaft were enrolled.

INTERVENTION: Reamed IMN fixation.

MAIN OUTCOME MEASUREMENTS: Reductions in cost ($292 per shaft) and metal waste (0.44 pounds [lbs]) per reamer shaft, reamer shaft failure (breakage and/or incarceration), superficial and deep infections.

RESULTS

A single surgeon treated 125 and 135 fractures before and after adoption of a reusable reamer shaft. No reamer shaft failures were identified. The before and after groups did not differ in age, OTA/AO classification, or infection rates. By adopting reusable reamer shafts, the surgeon avoided an estimated 54 single-use reamer shafts per year for an estimated cost and metal waste savings per year of $15,643 USD and 24 lbs. Over the same period that the surgeon switched to using reusable reamer shafts, a total of 283 single-use reamer shafts were used by 12 surgeons in the same department. If the entire department had adopted reusable reamer shafts during that period, an estimated 164 reamer shafts per year would have been avoided for a total cost and metal waste savings per year of $47,763 USD and 72 lbs.

CONCLUSION

Single-use reamer shafts represent an easily addressable source of extraneous cost and metal waste in orthopaedic surgery.

LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.